RESUMO
We report the use of plasmaleukapheresis (PLP) to treat renal allograft rejection which had failed to respond to conventional pulse corticosteroid therapy. Twenty-three patients who failed to respond to at least 3 boluses of IV methylprednisolone received PLP. Sixteen of these patients had either complete (12) or partial (4) response to PLP. In the responding group, the mean serum creatinine was 1.5 +/- 0.3 mg/dl. In the partially responding group, the mean serum creatinine was 3.9 +/- 0.3 mg/dl. Plasmaleukapheresis resulted in the reduction in levels of circulating immune complexes (CIC), and T and B cells. Circulating null cell levels increased. All 5 patients with low (less than 10%) pretransplant cytotoxic antibody levels had complete response to plasmaleukapheresis. We conclude that PLP, perhaps by removal of CIC, antibody and/or population of circulating T or B cells, may be capable of reversing steroid resistant rejection, especially in patients with low levels of pretransplant cytotoxic antibodies.